back to the future: reconsidering the role of the company clinic in us healthcare may 8th 2007...
TRANSCRIPT
Back to the Future:Reconsidering the Role of the Company Clinic
in US HealthcareMay 8th 2007
presented by
Raymond J. Fabius MD, CPE, FACPE President & CMO CHD Meridian
Bruce Sherman MD, FCCP Medical Director, Global ServicesThe Goodyear Tire & Rubber Company
2 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Our Agenda Today
• Introduction - Declare my Bias
• The Trusted Clinician at the Workplace
• The Emerging Health & Productivity Space
• Overview of Workplace Healthcare
– How it works
– Outcomes
• Best Practice Examples of Integration at Goodyear
– Primary Care & Disease Management
– Primary Care & Pharmacy
• Total Population Management
3 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
In The Spirit of Full DisclosureMy Background, My Bias
• Inner City Academic Pediatrician – 2 years
• Frontline Primary Care Provider – 10 years
• Local, Regional & Corporate Medical Director for Managed Care & Health Insurance Industry – 10 years
• Early framer of Utilization, Disease & Quality Management – written 2 books, many articles & book chapters
• Global Medical Leader of GE – 3 years – 230 health centers in 28 countries
• President & CMO of I-trax / CHD Meridian since May 2005
1. Nothing, Nothing supersedes the Trusted Clinician – Patient Relationship
2. Telephonic and Web-based programs can augment theTrusted Clinician – Patient Relationship
3. The Workplace is an excellent location to promote health
4 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Rating of Relationships
95
78
56
51
48
43
0 10 20 30 40 50 60 70 80 90 100
Family
Doctor
Spiritual Advisor
Co-Worker
Pharmacist
Financial Advisor
Ty
pe
of
Re
lati
on
sh
ip
Percentage
Source: Magee, J., Relationship Based health Care in the United States, United Kingdom, Canada, Germany, South Africa and Japan. 2003
The Trusted Clinician Can be a Powerful Resource
6 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
The Foundation of our Value Proposition:Leveraging the Trusted Clinician at the Workplace
The Doctor, Pharmacist, Therapist or Nurse who goes to work with you
Best Positioned to Influence Behavior Change
7 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Patients Complain About AccessDoctors Complain About Compliance
8 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Trusted Clinician’s Focus: 3 Levels of Prevention
• Primary - Lifestyle Change - Immunizations - Seat Belts
• Secondary - Compliance with guidelines - Screenings cancer
blood pressurecholesterol
• Tertiary - Compliance with Care - Disease Management
9 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Trusted Clinicians Improve Outcomes – Smoking Cessation
“An early meta-analysis showed an overallcessation rate of 8.4% at 6 months withbrief(<5 min) physician advice.”
“Since then, there have been several large studies ofphysician advice that have shown quit rates of up to 10%”.
New Developments in
Smoking Cessation
Allan V. Prochazka, MD, MSc
Chest. 2000;117:169S-175S.
10 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Trusted Clinicians Improve Outcomes - Mammography Screening
Analyses showed that the mostimportant variable that predictedwhether women of all racial groups hadmammogram, at any time or within thelast year, was whether their doctors haddiscussed mammography with them.
The effect of physician-patient communication on mammographyutilization by different ethnic groups.
Fox SA, Stein JADivision of Family Medicine, School of Medicine, University of California, Los Angeles.
Med Care. 1991 Nov; 29(11):1065-82
11 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Trusted Clinicians Improve Outcomes – Diabetic Care
“Periodic primary care sessions organized tomeet the complex needs of diabetic patientsimproved the process of diabetes care andwere associated with better outcomes”.
Chronic care clinics for diabetes in primary care: a system-wide randomized trial.Wagner EH, Grothaus LC, Sandhu N, Galvin MS, McGregor M, Artz K, Coleman EAW.A. MacColl Institute for Healthcare Innovation, Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington 98101Diabetes Care. 2001 Apr; 24(4):695-700
12 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
HHS - The Workplace is a great location for preventive programs
“Employers are becoming more awarethat obesity, lack of physical activity, andtobacco use are adversely affecting thehealth and productivity of theiremployees and ultimately, the businesses’bottom line.”
As a result:• Innovative employers are providing a variety of
work-site-based health promotion & disease prevention programs
• Significant return on investment for the employer (median ROI of $3.14)
13 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
The Trusted Clinician can reduce an employee community’s random access of care
Studies show: • half or more employees believe all doctors and hospitals provide the same care
• half or more employees are not aware of guidelines of care
• physicians referral patterns are based on consanguinity, friendship, financial ties and proximity.
The majority of an employee community seek validation from their trusted clinician before proceeding with a treatment decision.
14 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Leveraging the Trusted Clinician Creating Value thru Behavior Change
One Patient at a Time
Fitness
Environment
Medical Guidance
Wellness Illness
Managing the Medical
Community
BehaviorChange
Injury
LifestyleImprovement
Increased Compliance
15 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Leveraging the Trusted ClinicianCreating value – integrating care at the workplace
Wellness Screenings
Immunizations Fitness
Environment
Illness Rx
Disability Disease/Case Management
24 hour care
Environment Smoking Ban
Traditional Occ Health Safe Workplace
Cafeteria
Managing the Medical Community
Specialists Tests
Hospitals Treatment Options
Fitness Work Readiness
Ergonomics Work Hardening Return to Work
17 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Totality of Employee Health Related Costs
Medical 22%
Disability 4%
Productivity Loss 74%
Workers’ comp, sick leave & other wage replacement
Lost Productivity
Absenteeism
Subpar Quality
Employee and Customer Dissatisfaction
PresenteeismTurnover
Adverse Bottom Line Impact
DIR
EC
TO
TH
ER
CO
STS
Temporary Staffing
Replacement Training Administrative
Health Care CostsMedical CareHospitalizationPharmacyDiagnostic TestingBehavioral HealthPhysical Therapy
Illness & InjuryTravel to Off-site MD
Source: Integrated Benefits Institute, 2000
Overtime Pay
Missed Deadlines
18 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
The Connection Between Health and Human Capital is Significant
• Over 22% of working age adults report health-related work impairment in the past 30 days from chronic illness. Those with impairment average 6.7 lost days. Equivalent to 2.5 billion impaired days/year. -Kessler
• American Productivity Audit: Top 5 reasons for productivity loss result in $180 billion in lost time. -Stewart
• Illness and disability reduced total work hours by approximately 8.6%. Nearly 8.7 million Americans were completely unable to work. The loss to the U.S. economy represented about $468 billion. -Berger
19 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Top 15 Drivers of Lost Work Time
0
50
100
150
200
250
300
350
400
450
500
Sleep disorders
Depression
FatigueBack/neck
AnxietyHypertension
Other emotional
Arthritis
Obesity
Chronic pain
Headache
Irritable bowel
High cholesterol
Heart disease
Allergy
Los
t w
ork
day
s/10
0 F
TE
s
Absence Presenteeism
Source: Kessler’s HPQ – Adjusted to Workforce
20 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
$0
$50
$100
$150
$200
$250
$300
$350
$400
An
nu
al c
os
t p
er
em
plo
ye
e (
PE
PY
)
presenteeismabsenteeismST disabilityinpatientoutpatientERmedications
The Total Cost of Illness
Goetzel, et al. JOEM 2004allergyarthritis
depressiondiabetes
migraine
21 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Factors Affecting Health & Productivity
Health-related factorsPhysical health issues
Chronic diseaseAcute illness
Lifestyle issuesHealth risksPreventive care compliance
Behavioral healthOther factors: Demographics Caregiving Work/life imbalance
Financial concernsEmployer health benefits
Productivity-related factorsAbsenteeism
STD and LTD programsFMLA policiesSick leave policyEffect on team moraleValue of time in production
Workers’ CompensationPresenteeism
Work relationshipsJob security and controlHealth issues
Work issuesErgonomic issuesSafety concerns
23 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
• Offer a Comprehensive portfolio of on-site health services– Health Center & Pharmacy Services – 215 locations in 34 states
– Integrated Programs
• Wellness & Health Advocacy
• Disease/Case Management
• Disability Management
• Leverage a 40-year Proven Track Record
• Produce Industry-leading Research
• Share Best Practices Across a
National Clinical Community
• Provide Flexible Customized Solutions
• Focus on the Patient Experience
As The Workplace Healthcare Leader, We…
CHD Meridian Healthcare
24 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
CHD Meridian Diverse Customer Base: Providing Workplace Health to Fortune 500
25 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
• Patient Satisfaction• Access• Availability• Health Effects• Trusted Relationship
• Travel Medicine
• Injury & Illness• Return to Work• Occupational Health
• Emergency Preparedness
• Metric Driven• Clinical Excellence• Operational
Excellence• External Accreditation
• Direct Medical • Reduced Lost Time
• Health Advocacy
• Measurable ROI
Employer of Choice Workplace Safety
Cost SavingsQuality Care
The Workplace Health Value Proposition
26 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Fortune Magazine Identified Workplace Health as a Great Benefit for Employees
One of our clients was recognizedBecause:
“Healthy workers produce healthier profits at this investment bank, which is on our list for the ninth straight year. An unusually extensive onsite medical center provides consults and case management for employees and their families.”
Workplace health services was mentioned several times as the reason why a company achieved “Employer of Choice” status
27 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Risk Management Medical Management Population Management
25% 75%
Medical Surveillance
Exams
Injuries &Illness
WorkersCompensation
Ergonomics
OSHAReporting
DisabilityManagement
CaseManagement
AbsenceManagement
Wellness/Prevention
PrimaryCare
Health Advocacy
DiseaseManagement
ReferralManagement
Pharmacy
% of Employer Healthcare Related Costs
Corporate Health Services: The Challenge of Integration
Integrated Health and Productivity Management yields maximum ROI for employers.
Travel Medicine
UrgentCare
EmergencyPreparedness
Emergency Response
EAPBehavioral
Health
28 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
CHD Meridian Clients Compared to Major Stock Indices
6-M
ay-
03
19
-Ju
n-0
3
4-A
ug
-03
17
-Se
p-0
3
30
-Oct
-03
15
-De
c-0
3
30
-Ja
n-0
4
16
-Ma
r-0
4
29
-Ap
r-0
4
15
-Ju
n-0
4
29
-Ju
l-0
4
13
-Se
p-0
4
26
-Oct
-04
9-D
ec-
04
25
-Ja
n-0
5
10
-Ma
r-0
5
25
-Ap
r-0
5
8-J
un
-05
22
-Ju
l-0
5
6-S
ep
-05
19
-Oct
-05
2-D
ec-
05
19
-Ja
n-0
6
6-M
ar-
06
DJIA
S&P 500
Average CHDM Client
Index of the S&P 500, the DJIA &Index of the S&P 500, the DJIA &
the average price for our publicly traded clients. the average price for our publicly traded clients.
Our clients' average stock price has risen by 87%, Our clients' average stock price has risen by 87%,
compared to 51% for the S&P and 37% for the DJIA.compared to 51% for the S&P and 37% for the DJIA.
Index of the S&P 500, the DJIA &Index of the S&P 500, the DJIA &
the average price for our publicly traded clients. the average price for our publicly traded clients.
Our clients' average stock price has risen by 87%, Our clients' average stock price has risen by 87%,
compared to 51% for the S&P and 37% for the DJIA.compared to 51% for the S&P and 37% for the DJIA.
Successful Companies Utilize Our Workplace Health Solutions
30 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
TrustedClinician
Best in Class P&PCredentialing/Accreditation
Continuous ImprovementBenchmarking
Clinical Community
Globally Experienced & Double Boarded Medical Leadership
Leveraging the Trusted Clinician at the WorkplaceSupported by a Robust Clinical Community and Infrastructure
Policies and Procedures cultivated over 25+ years by highly trained and experienced medical and administrative staff dedicated to Workplace health.
Clinical Community of 1,400 professionals with varying skill sets and interests linked via web
Health Informatics
Item Number Performance Criteria J
JS
I T
ota
l
Eth
ico
n T
X
Eth
ico
n G
A
Eth
ico
n N
M
Eth
ico
n O
H
Eth
ico
n N
J
ORG Organizational Issues 1 1 1 1 1 1
ORG 1.0 Medical Department Organization 1 1 2 1 2 2
ORG 1.1 Current goals/objectives with action plans (attachment) 0 1 0 0 2 2
ORG 1.2 Goals are being met and/or methods by which progress will be attained 0 2 2 0 1 2
ORG 1.3 Reference books are available in medical department 2 1 2 2 2 2
ORG 2.0 Medical Records 1 1 1 1 1 2
ORG 2.1 Medical records kept in safe and secure place 2 2 2 2 1 1
ORG 2.2 Medical records are organized without loose items or non-medical items 2 1 2 2 2 2
ORG 2.3 Medical record access limited to medical personnel 1 2 2 2 2 1
ORG 2.4Consent for release of medical records within CHD Meridian Guidelines (review attached audit sheet) 2 1 2 1 1 2
ORG 2.5Personal and Occupational Health Information are maintained separately 1 2 1 2 0 2
ORG 2.6 Uses CHD Meridian policies and procedures to maintain confidentiality 2 2 2 2 0 2
ORG 3.0 Medical Record Documentation 1 1 1 1 1 1
ORG 3.1 Allergies are recorded in patient chart 0 0 1 2 2 2
ORG 3.2 Date/Time of encounter noted 1 1 2 1 1 2
ORG 3.3 Notes written in SOAP-D format 0 1 1 2 2 2
ORG 3.4 Subjective history is concise 0 2 1 2 1 1
ORG 3.5 Objective findings noted 1 2 1 0 2 2
ORG 3.6 Nursing diagnosis/medical diagnosis as appropriate 1 1 1 1 0 1
ORG 3.7 Treatment plan defined 1 2 2 1 1 2
ORG 3.8 Treatment plan includes patient education as indicated 1 2 2 2 2 1
ORG 3.9 Disposition noted 0 1 2 1 2 2
ORG 3.10 Tetanus immunization noted as appropriate 1 2 2 2 1 1
Robust Clinical Audits and Best Practice Benchmarking
31 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Primary Care (EEs, dependents and retirees)
Acute Care/ Urgent Care/ “Extended Episodic Care”
Emergency Care
Onsite Pharmacy Dispensing and Counseling
Occupational Illness and Injury Treatment Arrange Transportation for Ill or Injured Ergonomics
Onsite Health Education / Wellness Programs
Disease Management
National Influenza Program
Assist with Self Monitoring Programs
Administer Approved Injectables
Blood Pressure Monitoring
International Travel Health Services Disability Management, Including STD, LTD, & FMLA
Pre and Post Natal Support
Lactation Support
Laboratory Services
Specialty Care (Women’s Health, Cardiology, etc)
Medical Surveillance
Global / National Drug Screen Testing
Counseling & Crisis Intervention
Employee Advocacy
Disaster Preparedness
Pharmacy Concierge
Return to Work Examinations
Schedule Annual Physicals
Physical Therapy/Rehabilitation
Compliance: OSHA , AED, CLIA and VIS
Develop / Con tract with Referral Network
Maintain Health & Safety Records
Maintain Emergency Equipment Corporate Medical Director Oversight and Standing orders Medical Emergency Planning
Workplace Health Services PortfolioMutually determined based upon drivers and needs
32 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
IntegratedPBM
(Retail, Mail andSpecialty)
IntegratedMail Order Rx
IntegratedWith PC
(power of pen)
Workplace Pharmacy: Concierge to Fully Transparent, Integrated PBM
Urban Central Fill
ConciergeService
(Drop-off/ Pick-up)
Pre-PackagedRx
Human Resource/ Benefits Impact
Cost
Savin
gs
Require On-site Services
On-SitePharmacy
(Stand-Alone)
33 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Determining WHERE Workplace Health “Fits”Geographic Sizing Guidelines
• Optimal Environments Defined by Scope of Service:
– On-Site Primary Care – ~1,750+ EE’s in geographic area,• especially where retirees and dependents are proximate
– On-Site Rx – ~1,750+ EE’s in geographic area(~30,000 scripts/yr)
– On-Site Occupational Health – ~500+ EE’s but more a function of worksite environment
– On-Site “Corporate Health” – ~1,000+ EE’s but more a function of corporate culture
– On-Site Wellness Coach / Disease Management Care – 250+ EE’s often coupled with Health Informatics & HRA data
• Coalition Model leverages multiple employers for critical mass and purchasing leverage
35 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
• When comparing the CHD Meridian health center’s performance to the client’s experience with their national PPO plan:
– The primary health care was 12% less expensive
– There were 30% less hospitalizations
– There were 42% less days spent in the hospital
– The length of stay in the hospital was 17% shorter
– The pharmacy costs are two times greater than expected
o Improved Compliance (72% higher utilization)
• CHD Meridian management charges were reasonable
• Very high patient satisfaction with providers and the benefit offering
Independent Assessment:Primary Care / Pharmacy Health Center: Large Southeast Paper Company
36 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Study Design – Control vs. Study Groups
Primary Care/ Rx Site
1. Chronically ill patients 4X more likely to use CHD Meridian for primary medical care
2. Chronically ill patients who utilize the Medical Center for primary care exhibit:
• More Primary Care Visits - 24% more total office visits per year
• Less Hospitalization - Inpatient admission rate reduced by 50%
• Less ER/Hospital Use - Hospital outpatient visits reduced by 42%
• Less need for referral - Community office visits are reduced by 36%
• Less prescriptions / More Use of Mail Order - PBM scripts are reduced by 61%
Cross Sectional AnalysisPatients With A Chronic Disease
Annual Per Patient Healthcare Costs
$1,386
$1,621
$4,849
$6,394
$0 $2,000 $4,000 $6,000 $8,000
Use MedicalCenter
Do Not UseMedicalCenter
Medical Pharmacy
629 Patients
528 Patients
Medical claims costs reduced by 32%Pharmacy claims costs reduced by 17%
Total medical and Rx costs reduced by 29%
Medical claims costs reduced by 32%Pharmacy claims costs reduced by 17%
Total medical and Rx costs reduced by 29%
Study #1: Saving Money Managing Chronic Illness within a Mining Community – CHD Meridian Care vs. Community Care
38 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Step 3: Notify Health Center
Step 5: Notify
Telephonic Call Center
Step 2: Identity
people to help
Health Informatics
Telephonic Care Support
Electronic Tools
Step 1:Search
Database
Health Center
Integrated Disease Management Process
Step 8: ID & loading
of new members Step 4:
Patient Visit to Health
Center Flow Algorithm
Step 6:Care
Assessment
Step 7: Patient Action Plan
• Predictive Modeling• Population Assessment• Clinical/ ROI Reporting• Study Design and Execution
Member
39 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
The Integration of Primary Care & Pharmacy: The Power is in the Prescribing – Dispensing Collaboration
Human Capital / Benefits Impact
Cost
Savin
gs &
Clin
ical In
ten
sit
y
Drug to Disease
Split Pill
FormularyGenericsOTC
Step Therapy
Incentives
Drug to Drug
ScorecardPrescribing
FeedbackPrescribing
Goals
Pharmacy Administration
Clinical Pharmacy
Medical PharmacyInterface
Medical Pharmacy
Management
Best Demonstrated Employer Programs in Health Management:
Bruce Sherman MD, FCCP Medical Director, Global ServicesThe Goodyear Tire & Rubber Company
41 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
In The Spirit of Full DisclosureMy Background, My Bias
• Inner city emergency physician – 3 years
• Urban academic intensivist/pulmonologist – 9 years
• Corporate medical director and consultant in workplace health – 9 years
• Areas of focus include disability management & workforce health management strategies – many publications and presentations
• Medical Director, Global Services at Goodyear – recent appointment
1. Employer-driven health initiatives must be better integrated
2. One way to do that is by leveraging the trusted clinician – patient relationship to engage employees
3. The workplace is an excellent location to promote health
43 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Integration of Primary Care & Disease Management: Workplace Health Center Drives Improved DM Engagement Rates N=320 patients enrolled in IDM at Gadsden (recently published in Journal of Disease Management1)
52%
21%10%
96%
76%
40%
100% 100%
0
0.2
0.4
0.6
0.8
1
1.2
Eligible Contacted Participant BehaviorImprovement
Traditional DM* Integrated DM
(Projection)
* Lynch et al. Documenting Participation in a DM Program. JOEM 2006; 48(5)
1 Frazee et al. Leveraging the Trusted Clinician: Documenting Disease Management Program Enrollment. Disease Mgmt 2007; 10:16-29
44 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Engagement Correlates to Depth of Relationship:Our Doctors, Pharmacists & Nurses Enhance Engagement N=693 patients enrolled in DM at Gadsden (recently published in Journal of Disease Management)
Engagement Rates
0%
20%
40%
60%
80%
IDM RX only Acute CareUser
TraditionalBOB
45 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Integration of Primary Care & Disease Management: Workplace Health Center Drives Improved Retention RatesN=684 patients retained in IDM at Gadsden for several months
25%
12%
76%72%
0%
25%
50%
75%
100%
IDM Traditional DM*
Initial After several months
* Lynch et al. Documenting Participation in a DM Program. JOEM 2006; 48(5)
Preliminary Results
46 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Early Signs of Clinical Outcome Improvements:IDM Coronary Artery Disease Patients Reduce Cholesterol Levels
(good)
7 points
5 points
21 points
1 point
Preliminary Results
mg
/dL
47 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
96% Would Recommend Program!N=141
50% 60% 70% 80% 90% 100%
I would recommend thisprogram to co-workers and
friends.
My Nurse Coach & HealthCenter staff worked well
together to help me.
The program has helped mecommunicate better with my
physician.
The program has helped meimprove my health.
The materials I received wereuseful.
The materials I received wereeasy to read.
I have learned a lot about mycondition through the program.
“Talking to the nurse is like therapy. Always has an encouraging word..”
Preliminary Results
48 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Cost Trend Improvement for IDM EnrolleesComparing Apr-Sept 2005 to Apr-Sept 2006
IDM Enrollee v. Non Enrollee Cost Trend
$0
$100
$200
$300
$400
$500
$600
$700
Apr-Sept 2005 Apr-Sept 2006 Projected Apr-Sept 2007 atTrend
PM
PM
Cos
t
All IDM Enrolled All IDM Non-Enrolled
•IDM Enrollee Costs decreased by double digits
•Non Enrollee Costs increased by ½ general trend
(All invitees considered to be in top 30% of avoidable cost patients and receiving primary care at workplace)
Preliminary Results
50 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Integration of Primary Care & Pharmacy: Evidence-based prescribing practices generate value(published this month in the Journal of Health & Productivity)
Figure 2Antibiotic Line and Average Cost: Workplace Treated v.
Community Treated
0
10
20
30
40
50
60
70
% 1st Line % 2nd Line % 3rd Line Average Cost/Rx($)
Workplace Treated
Community Treated
66%
45%
8%
22%
$20
Better Care – and a Potential Savings of $1.5 Million for Antibiotics Alone
51 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
A vision of integration
May not be copied or disseminated without the express consent of The Goodyear Tire & Rubber Company.
52 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
Population Health ManagementApplication Tools
Well
No Disease
PrimaryPrevention
-Screening
Health Education
At Risk(Obesity
High Cholesterol)
-Health RiskAssessment
-Targeted RiskReduction Programs
-- Risk Modeling
- Incentives
- Competitions
- Ergonomics
Acute Illness/
Discretionary Care
(Doctor Visits
Emergency Visits)
- Nurse Advice Line
- Web tools
-- Consumer Directed Health Plan
Chronic Illness(Diabetes
Coronary Heart Disease)
-Disease Management
-Incentive Design
-Self Management Training (Health Coaching)
Catastrophic(Head Injury
Cancer)
-Case Management
--Decision Support
-- Predictive Modeling
85% members = 15% cost
15% members = 85% cost
53 Confidential; Copyright © 2007 by CHD Meridian Healthcare, LLC - All Rights Reserved
In Summary
• The Trusted Clinician at the workplace is a key member of the health care team
• While individual health-related programs may provide benefit, integration maximizes value
• Trusted Clinicians can facilitate integration of health benefits programs to optimize use
• Workplace healthcare can generate significant value for employers